Fractures of the Skull, Face, Jaw, Upper Body, Arm and Hand, and Ribcage

A skull fracture is a very serious injury since it is often associated with some form of damage to the brain, Concussion and compression may both accompany skull fractures. If a person has a fracture to the bones of the face or jaw, the airway is your overwhelming priority.

TREATING A FRACTURED SKULL

1. Keep the victim still while she is conscious. Encourage her not to move her head.
2. Keep a constant check on the airway, breathing, and circulation.
3. Be prepared to resuscitate or turn into the recovery position if necessary.
4. Call for emergency help as soon as possible.

HOW TO TREAT FRACTURES OF THE FACE AND JAW

1. Ensure that any blood in the mouth is allowed to dribble out-- encourage the victim to spit into a bandage or handkerchief.
2. Gently remove any teeth or bits of broken bone from the mouth and give the victim a pad to hold against the injured part for additional support and comfort.
3. A cold compress may help to reduce pain.
4. Get the victim to hospital because she will require medical treatment.
5. Do not pinch a broken nose to control bleeding-- hold a pad under it.

SIGNS AND SYMPTOMS OF A SKULL FRACTURE

Along with these signs and symptoms, consider what happened. Skull fractures may be caused by direct and heavy impact to the head or by indirect impact, for example, a fall from a great higher on to the feet that may have cause the force to move up the body, stopping when it hit the skull.

• Bruising to the eye socket
• Pain
• A bump or a dent
• Straw-colored fluid coming from one or both ears
• Deterioration in the level of consciousness of the victim

Does the person respond slowly to questions pr commands? Is he having problems focusing?

If any of these things is present, assume a skull fracture with a potential injury to the brain.

CONCUSSION

In itself, concussion is not a serious injury as the victim will recover when the disturbance caused by the impact stops. However, because concussion often accompanies violent head movement, there is always the possibility of a skull fracture or more serious, longer-term brain injury, such as compression. It is important therefore that even a seemingly recovered victim with concussion should seek medical treatment.

HOW TO TREAT CONCUSSION

1. Place the victim in the recovery position if necessary and monitor ABC.
2. Call an ambulance if the victim does not recover after 3 minutes or if there are signs of skull fracture or compression.
3. Advise the victim to seek medical advice if recovery appears to be complete.
4. Encourage the victim to keep still while recovering because this reduces dizziness and nausea.
5. Be aware of the increased likelihood  of neck injuries.

COMPRESSION

Compression is a very serious injury that occurs when pressure is exerted on the brain, either by a piece of bone, bleeding, or swelling of the injured brain. It may develop immediately after a head injury or stroke, or some hours or even days later.

SIGNS AND SYMPTOMS OF COMPRESSION

• Person becomes increasingly drowsy and unresponsive.
• Flushed and dry skin.
• Slurred speech and confusion.
• Partial or total loss of movement, often down one side of the body.
• One pupil bigger than the other.
• Noisy breathing  which becomes slow.
• Slow, strong pulse.

HOW TO TREAT COMPRESSION

If some or all of these symptoms are present, suspect compression and carry out the following treatment.

1. If the victim is unconscious, place in the recovery position and monitor airway, breathing, and circulation.
2. If conscious, lay the victim down with the head and shoulders slightly raised, maintaining a close check on the ABC. Call an ambulance, and be prepared to resuscitate.

WARNING!

Do not give anything to eat or drink-- the victim may need a general anesthetic in hospital.

FRACTURES OF THE UPPER BODY
The collarbone can be broken by direct impact. However, it is most commonly fractured by indirect force moving up the arm following a fall on to an outstretched hand, and often happens after a fall from a bicycle or a horse. A broken shoulder often follows a heavy impact to the site of injury. It is therefore important to do a careful examination to rule out back or rib injury.

BROKEN COLLARBONE. Along with potential swelling, bruising, and tenderness above the site of the injury, the victim is most likely to be supporting the injured arm, with the shoulder on the injured slumped. Since the collarbone is close to the skin it is particularly important to look for an open fracture.

BROKEN SHOULDER.  If you are confident that the shoulder itself is broken then the treatment is to work with the victim to find the best position. The application of an arm sling may provide some support, but more commonly the victim will want no bandages, setting instead for steady support from another person if available. The pain of the injury may make it necessary to call for an ambulance rather than transporting the victim to hospital in a car.

WARNING!
Do not give anything to eat or drink-- the victim may need a general anesthetic in hospital.

TREATMENT. If the bone has pierced the skin, place a light dressing over the wound. Bleeding is likely to be minimal and your main concern is to prevent infection.
     Work with the injured person to find the most comfortable position for the arm and for the body as a whole. Generally this will be sitting up with the arm supported at the elbow. The victim may wish to go to hospital in this position, but she should be offered the option of an elevation sling, which will help alleviate pressure on the collarbone and provide some comfort.

APPLYING AN ELEVATION SLING. The elevation sling has a range of uses. As well as the treatment of a broken collarbone, it also provides comfort in the treatment of crushed or broken fingers and hands, relief in the treatment of burns to the arm, and is an aid in controlling bleeding through elevation.

1. Place the injured arm with the fingers by the collarbone on the uninjured side.
2. Place the triangular bandage with the point resting at the elbow on the injured side.
3. Tuck the bandage underneath the hand and down underneath the injured arm.
4. Tie at the collarbone in a square knot (or a bow)
5. Fasten the spare material at the elbow with a pin or twist it and tuck it away.
6. Extra support can be gained by placing a triangular bandage folded into three (a broad fold) around the arm and body.

FRACTURES OF THE ARM AND HAND AND RIBCAGE

There are three long bones in each arm-- one in the upper arm and two below the elbow. These are among the most commonly broken bones in the body. There is also a number of small bones in the wrist that are vulnerable to breaks. Fractures to the hand or fingers can be extremely painful because of the many nerve endings.

The principles of treatment are, as for all broken bones, to provide support to the injured part and to stop it from moving too much. Most people with a broken arm will be able to make their own way to the hospital or health center, so treatment focuses on providing support that is appropriate when walking and stabilizes the injured limb. This can be done with an improvised sling using clothing, or by using a triangular bandage to form an arm sling.

HOW TO MAKE AN ARM SLING

1. Gently place the bandage under the victim's arm, placing the point underneath the elbow.
2. Pass the top end of the bandage around the back of the victim's neck, leaving a short end to be tied by the collarbone on the injured side.
3. Bring the bottom end of the bandage up carefully, ensuring that it fully supports the injured arm. Tie into place with a square knot or bow.
4. For additional support, you can tie another triangular bandage. Fold into three (a broad fold) around the arm, avoiding the site of the fracture, to stop the arm from moving.

BROKEN ELBOW OR AN ARM THAT CANNOT BEND. If the broken bone is on or near the elbow it may not be possible for the person to bend the arm, either because of the pain or because the joint is fixed. In this case you need to treat the arm in the position found-- do not try to bend the arm.

1. Help the victim into the most comfortable position; this will often be lying down on the ground, but it may also be standing up with the arm hanging straight down.
2. Place padding around  the injured part, both between the arm and the body and on the outside of the arm.
3. The victim will need to be transported by ambulance. Do not attempt to bandage the arm if help is on its way because this will cause further discomfort and may make the injury worse.

FRACTURED WRIST. In older adults, the wrist may be broken by a fall onto an outstretched hand, causing a break very low down on the radius (one of the long bones in the lower arm) known as a Colle's or silver fork fracture. Other injuries can break one of the small bones to the wrist or cause a sprain that is particularly difficult to distinguish from a break.

TREATMENT. Provide support and immobilization in the same way as for a break to the upper or lower arm. Remove watches and bracelets because these may contribute to cutting off circulation to the hand if the injury swells.

HAND FRACTURES. Direct impact may break one or two of the small bones in the palm or fingers. Crushing injuries may break several bones and cause considerable bleeding. In addition the thumb, and even some of the fingers, may become dislocated.

TREATMENT

1. Gently cover any open wounds with a dressing or clean, non-fluffy piece of material. Encourage the victim to raise her arm. This helps to reduce swelling and bleeding and also provides some pain relief.
2. If possible, remove rings and wrist-watches before the injury starts to swell. If jewelry has been crushed into the hand or swelling prevents its easy removal, pass this information on as soon as possible to the medical staff as early treatment will be needed to prevent damage to the circulation in the fingers.
3. Cover the injured area with a pad of soft fabric or cotton wool (taking particular care if there are open wounds not to get strands of material stuck into the injury). This padding can be held in place with a cover created from a triangular bandage, which can also be adapted for crush injuries to the foot and for burns to the hand or foot.

FRACTURE OF THE RIBCAGE

Simple fractures, characterized by bruising and tenderness over the fracture site, are usually confined to one broken rib, with no underlying damage to the lungs or to other internal organs. Multiple, or complicated, rib fractures will often result in the victim having difficulty in breathing, as the chest wall is unable to move effectively. There may also be lung damage. Broken ribs are generally not strapped up because the chest needs to expand normally during breathing to reduce the risk of pneumonia.

TREATING A SIMPLE BROKEN RIB. The best treatment for a simple fractured rib is to put the arm on the injured side into an arm sling and to advise the victim to seek medical aid.

MULTIPLE BROKEN RIBS. In a case of multiple rib fractures there may also be lung damage, in which one or a number of ribs have punctured one or both of the lungs. There may also be an open break on the chest wall where ribs have sprung out. Remember that the ribs extend around the back of the body and there may be injuries here as well as on the front. Rib injuries may be accompanied by a sucking wound to the chest, creating a direct passage between the external environment and the lungs.

1. Treat any sucking wounds by covering, initially with a hand and then with plastic. Treat any open breaks.
2. If the victim is conscious, lay him down. He is most likely to find breathing easier in a half-sitting position.
3. Lean the victim toward the injured side. This allows any blood to drain into the injured lung, leaving the good lung free to breath. Place the arm on the injured side into an elevation sling.
4. Treat for shock.

If the victim loses consciousness, monitor the airway and breathing and place the person into the recovery position with the injured side upward.

WARNING!

Do not give anything to eat or drink-- the victim may need a general anesthetic in hospital.

By: Unknown On 3:41 AM

Continue Reading

Fractures, Dislocations, and Soft Tissue Injuries (How to Treat Fractures)

Fracture is just another word for a broken bone. A dislocation occurs at the site of a joint and is where a bone is fully or partially displaced. Soft tissue injuries include sprains, strains, and ruptures. They are often caused in the same way as fractures and generally are hard to distinguish from broken bones.

BROKEN BONES. There are two main types of broken bone. The first is a closed (simple) break or fracture, where the bone has broken but has not pierced the skin. A closed fracture is sometimes difficult to diagnose, even for experienced medical staff, who will usually rely on an X-ray to determine whether or not the bone is definitely broken. The second type is an open (compound) break or fracture, where the bone has either pierced the skin or is  associated with an open wound. The greatest risk with open breaks is infection. Both open and closed breaks can result in injury to underlying organs or blood vessels and may also be unstable if the ends of the broken bone are moving around. In young children the bones are not fully formed and may bend rather than break (termed a greenstick fracture).
     While it is possible to give some general guidance for the recognition of broken bones, no two people are identical in their response. The first general rule therefore is, if in doubt, assume that a bone is broken and treat as such. Be particularly aware of potential fractures if the accident involved a sharp blow, a fall, a rapid increase or decrease of speed, or a sudden twist.

DISLOCATIONS. The most common sites for dislocations are the shoulders, thumbs, and hips. Dislocations are usually characterized by intense pain and an obvious deformity. There may be signs and symptoms similar to a broken bone, including feelings of tingling or numbness below the site of the injury, caused by trapped nerves or blood vessels. Do not attempt to replace the bone. Make the victim comfortable and take or send him to hospital.

SOFT TISSUE INJURIES. Strains are an overstretching of the muscle, leading to a partial tear. Ruptures are complete tears in muscles.Sprains are injuries to a ligament at near a joint. The signs and symptoms of soft tissue injuries will be similar to the signs and symptoms of a fracture and will generally follow a sharp twisting or stretching movement.

SIGNS AND SYMPTOMS OF BROKEN BONES
Pain. This accompanies most, but not all, fractures and is caused by the broken bone ends pressing on nerve endings.

Deformity. An injured part may appear deformed, particularly when compare to the uninjured side.

Swelling. Some swelling may be present at the site of a fracture.

Tenderness. This accompanies most broken bones and can often only be felt when the injured part is gently touched.

Shock. The signs and symptoms of shock will often accompany major fractures. There may be reddening or bruising over the site of the break, but this often takes some time to appear. You may also hear the ends of broken bone rubbing together, a sound known as crepitus.

Another potential sign of a broken bone is lack of feeling or tingling sensation below the fracture site. This may indicate nerve damage or a reduction in circulation caused by the bone pushing on either the nerves or the blood vessels. The treatment for injuries displaying these symptoms is the same as for any broken bone. However, if you have been trained to do so, applying traction may alleviate the problem.

If the victim is displaying any combination of this signs and symptoms or the nature of the accident suggest that a fracture is likely, assume that a bone is broken.

HOW TO TREAT FRACTURES
The general rule for treating all broken bones is to immobilize them, because this reduce pain and the likelihood of further injury. The risk of infection is also and important consideration in the treatment of open fractures and requires action. Do not give a person who has a broken bone anything to eat or drink in case he needs a general anesthetic in hospital.

KEEPING A BROKEN BONE STILL

1. The victim will often have put the injured part in the position that is most comfortable for him and will generally be guarding the injury and keeping it still. If the victim has not done this, encourage him to keep still and help him into a comfortable position.
2. Once the victim is still you can help to steady and support the fracture using your hands. By helping the victim keep the injured part still you enable him to relax. The very act of relaxing the muscles reduces the pull on the broken bones and often alleviates pain.
3. If you have to transport the victim yourself, or if it is going to be a while until help arrives, then you can immobilize the broken bone further with bandages or improvise with a coats or blankets, for example.

The key points to remember with any type of bandaging are:

• Not to tie the bandage too tightly.
• To pad around the site of the break.

Do not move the injured area unnecessarily.

1. Place the dressing over the wound and build up padding alongside the bone.
2. Tie both the padding and the dressing in place, using firm pressure.
3. Remember that broken bones do swell and that you may need to loosen the bandage if the circulation below the site of the break becomes impaired.

TREATMENT OF OPEN BREAKS. In the first instance, the wound should be protected using either a sterile dressing or an improvised dressing made from a piece of clean, dry, and non-fluffy materials. If the bleeding is profuse, or you are going to have to wait some time for further help, this dressing should be held in place using the same principles as you would apply if there were a foreign object in the wound.

CHECKING FOR DAMAGE TO CIRCULATION

With any bandaging, you run the risk of cutting off the circulation to the area below the site of the bandage. While this can in part be avoided by not trying bandages too tightly and by never using a tourniquet, the nature of wounds means that they swell and this can cause a once satisfactory bandage to become too tight. There are a number of ways to check whether a bandage is cutting off circulation:

• If the skin below the site of the bandage becomes white, gray, or blue, or feels cold to the touch.
• If the victim complains of tingling, numbness, or of a lack of circulation.
• If the pulse in the limbs slows or stops.
• If the color does not quickly return to the skin after the skin is gently pinched or the nail compressed.

If you notice any of these signs, gently loosen, but do not remove, the bandage until the blood flow returns.

By: Unknown On 2:26 AM

Continue Reading

Internal Bleeding, Eye Wounds and Embedded Objects

Severe internal bleeding is a potentially life-threatening condition. While the blood may not be obvious, it is still lost from the circulatory system and the victim is therefore very likely to go into shock. Internal bleeding may also cause a build-up of pressure that, in areas such as the skull or around the heart, can cause serious problems, loss of consciousness and, if untreated, lead to death.

SITES OF BLEEDING. Internal bleeding can be very difficult to identify, It is not unusual for internal bleeding to happen slowly, with signs and symptoms showing up days after an accident. It can happen to any part of the body but the richness of the blood supply in the stomach, around the organs such as the liver and the spleen, and in the bowel make these sites particularly vulnerable. Internal bleeding is also likely to accompany some broken bones. The thigh bone protects the femoral artery and if broken may pierce it, causing a large and life-threatening bleed.

TREATMENT

1. Treat for shock. Keep the person warm. Place him in a comfortable position, preferably lying down with the legs slightly raised. Reassure him. Treat any external bleeding or bleeding from orifices.
2. Call 911 as soon as possible and explain what has happened. Monitor and record the person's pulse and breathing rates. This information will be useful for the medical staff in determining the extent of the injury.

If the person becomes unconscious, place in the recovery position and monitor airway and breathing. Be prepared to resuscitate in necessary.

MAJOR ORGANS SUSCEPTIBLE TO INTERNAL BLEEDING

Internal bleeding can happen in any part of the body but the stomach, the liver, spleen, and intestines are particularly vulnerable because they have a rich blood supply. Internal bleeding can be very difficult to identify and signs and symptoms may not arise until several days after an accident has occurred.

SIGNS AND SYMPTOMS

• The person is known to have had an accident (not necessarily in the immediate past)
• Signs and symptoms of shock
• Bruising
• Boarding-- this most commonly occurs where there is bleeding into the stomach area; the quantity of blood combined with the tissues swelling result in a rigidity to the tissues
• Swelling
• Bleeding from body orifices

If there is any combination of these signs and symptoms, suspect internal bleeding.

BRUISING

Less serious internal bleeding such as small bruises can be treated with a cold compress to relieve pain and reduce swelling. However, the possibility of further internal bleeding or underlying injury should not be ruled out, particularly if the victim is known, for example, to have hit his head on a window during a traffic accident, or has been hit in the stomach by a reversing automobile.

EYE WOUNDS AND EMBEDDED OBJECTS
Cuts to the eye can be very frightening and even small, difficult to notice injuries are potentially very serious. However, medical treatments mean that even injuries that appear to be very severe may not necessarily result in the loss of sight in the eye. Do not touch the affected eye.

TREATMENT
Prevent further injury and get medical help as soon as possible.

1. Lie the person down, on his back if possible, and hold the head to prevent movement and keep it stable.
2. Ask the person to try to keep his eyes still to prevent movement of the injured eye. Ask the person to focus on something to prevent movement.
3. Ask the victim to hold a clean pad over the eye to help prevent movement and infection. If the wait for an ambulance or other help may take some time, you may wish to hold the pad for the person or to gently bandage it in place. However, because blood loss from the eye area is not likely to be life-threatening, any bandage should be use only to hold the pad in place and not to apply pressure.

Do not attempt to remove any object embedded in the eye. If the object is very long, then gently support it to prevent movement at its base. If small, ensure that the pad you place over the eye does not push it in any further.

TREATING AN OBJECT EMBEDDED IN THE WOUND

The first step in the treatment of any external bleeding is to check the extent of the injury and see if there is anything  embedded in the wound.

1. Apply pressure around the edges of the wound using your hands or the victim's hands without pressing on the object.
2. Replace this pressure with a dressing or clean material and bandage firmly in place, avoiding pressure on the object.
3. Raise the injured limb if possible to staunch the flow of blood.
4. Prevent longer objects from moving by supporting them with your hands or by packing around the base of the object with blankets.
5. Treat for shock and reassure the victim.

If the victim is impaled on something which cannot be moved, support him or her to stop from pulling on the impaled object and causing further damage. Where possible, treat the victim and ensure that the emergency team is aware of the need for cutting equipment.

WARNING!

If there is something stuck into the injury, do not attempt to remove it because:

• If the object went in at an angle, you may cause more damage pulling it out
• You may leave splinters in the wound
• The object may be pressing against a vein or an artery, reducing blood loss
• You may have mistaken a broken bone for a foreign body

The principles of applying pressure, elevating, and treating for shock still apply.

By: Unknown On 11:55 PM

Continue Reading

Treating Chest or Abdominal Wounds and Crush Injuries, Impalement, and Amputation

The chest wall protects the lungs, heart, and other essential organs such as the liver. A puncture wound to the chest can therefore be extremely serious. Wounds to the abdomen (stomach and intestine) are very serious. External bleeding may be severe and internal bleeding is likely, both of which will lead to serious shock. In addition, there may be damage to internal organs and the digestive system.

CHEST WOUNDS. Common complications of penetrating chest wounds include:

• Collapsed lung (pneumothorax), caused by air entering the space between the chest wall and the lungs. This applies pressure to the lungs, causing them to collapse. The lung can also be damaged directly, causing it to fill with blood.
• Tension pneumothorax which occurs when the pressure builds up sufficiently to affect the uninjured lungs and possibly even the heart.
• Damage to vital organs such as the liver-- this will result in severe shock as these organs have a large blood supply.

TREATMENT

1. Seal the wound using, in the first instance, your hand or the victim's hand.
2. Help the victim into a position that makes it easier for him to breathe. This will  usually be sitting up and inclined to the injured side. This allows the uninjured lung maximum room to move and allows blood to pool on the injured side.
3. Cover the wound with a dressing and cover the dressing with airtight material, such as plastic or foil. Seal this on three sides.
4. Call an ambulance and treat for shock.

If the victim is unconscious, monitor and maintain the airway, and be prepared to resuscitate if necessary (sealing the wound before resuscitating). Place the victim injured side down.

SIGNS AND SYMPTOMS OF CHEST WOUNDS

• Difficulty with breathing
• Shock
• Bright red, frothy blood (blood with air in it) being coughed up or escaping from the wound
• Pale skin with blue lips
• Sound of air being sucked into the chest

TREATING ABDOMINAL WOUNDS

1. Call an ambulance and help the victim to lie down in the most comfortable position.
2. Consider the position of the wound. If it is vertical-- runs down the abdomen-- moving the victim so that he is lying flat on the ground will help bring the edges together, ease discomfort, and help reduce bleeding. If the wound is horizontal, gently raising the legs will have the same effect.
3. Place a large dressing over the wound and secure in place. Add pads to this dressing as necessary.
4. Treat for shock.

Support the wound if the victim coughs, vomits, or needs to be moved into the recovery position. Press lightly on the bandage to prevent intestines protruding from the wound. If intestines are protruding, do not attempt to replace them. Cover with a clean piece of plastic film.

CRUSH INJURIES, IMPALEMENT, AND AMPUTATION
Crush injuries generally result from serious car accidents or explosions. There may be part of the body trapped under heavy debris; several broken bones, multiple external bleeding and much internal bleeding; burns from an explosions; severe shock, and deterioration into unconsciousness. If a person is impaled on an immovable object, treatment is similar to that for a foreign object embedded in a wound. An amputation is where a part of the body has been severed. This may occur through a straight and heavy cut or through twisting and pulling under extreme force.

TREATING CRUSH INJURIES

1. Ensure that it is safe to approach the scene. If in doubt, call 911 and wait for help.
2. Monitor and maintain airway and breathing and be prepared to resuscitate in necessary.
3. Treat major bleeding and cover smaller wounds with sterile dressings.
4. Keep the injure person still and try to reassure him or her while waiting for help.
5. Treat for shock.
6. Make an early call for an ambulance and inform medical staff what has happened.

IF THE INJURED PERSON IS TRAPPED. There are additional risks for the injured person if any part of the body is trapped. Releasing the body may bring on severe shock as fluid leaks to the injured part.

     An ever greater cause for concern is "crush syndrome." Toxins build up around the injury site and are trapped by an object crushing the person. If the object is removed, these toxins are suddenly released into the body, and the kidneys, the organs chiefly responsible for flushing out toxins, are overwhelmed. This condition can be fatal.

IF THE PERSON HAS BEEN TRAPPED FOR LESS THAN 10 MINUTES. Crush syndrome take some time to develop. If you can do so, safely remove the object. Treat as for crush injuries.

IF THE PERSON HAS BEEN TRAPPED FOR LONGER THAN 10 MINUTES. Make an early call for help, explaining the situation, but do not remove the object. Treat as for crush injuries and reassure the person.

TREATING AN IMPALEMENT

1. Do not attempt to remove the object or to move the injured person.
2. Provide swift assistance for the injured person, supporting his body weight where possible to prevent any further damage.
3. If bleeding is severe, apply pressure around the edges of the wound without pressing on the object.
4. Try to stop the object moving around as much as possible, enlisting bystander support where available.
5. Call an ambulance, make sure that you explain the need for cutting equipment or tools.
6. Treat for shock as best you can.

 TREATING AMPUTATION

1. Your priority is to stop any bleeding at the site of injury. Apply direct pressure and raise the injured stump. An amputation high on the arm or leg can be accompanied by severe arterial bleeding, particularly if caused by a twisting or tearing movement. Be prepared to apply continuous pressure using several pads as necessary.
2. If the bleeding comes under control, cover the wound with a sterile dressing or clean non-fluffy material tied in place with a bandage.
3. Treat for shock and reassure the person.
4. Call 911, advising that there is an amputation.

FOR THE AMPUTATED PART

A surgeon may be able to reattach the amputated part.

1. Wrap the part in a plastic bag and wrap the bag in a clean cloth.
2. Place the cloth-wrapped bag in ice and place into a sturdy container. Do not let the ice come into close contact with the amputated part, because this will damage the flesh. Do not wash the amputated part.
3. Label the container with the time of injury and the victim's name and make sure that you personally hand it over to medical staff.

By: Unknown On 10:12 PM

Continue Reading

Diabetes and Bleeding

Diabetes mellitus is a medical condition in which the body is unable to effectively regulate the amount of sugar in the blood. The pancreas (an organ in the body) normally produces a hormone called insulin that regulates blood sugar level. In a person suffering from diabetes this does not happen effectively and as a result blood sugar levels become too high (this is known as hyperglycemia). Most diabetics control the condition through a combination of diet and injections of insulin. Too much insulin can lead to a condition known as hypoglycemia (low blood sugar).

HYPERGLYCEMIA. Hyperglycemia is most likely to occur in an undiagnosed diabetic. Diabetes is generally first noticed in early adolescence or middle age. If left untreated, a high blood sugar level will lead to unconsciousness and death. Onset may be gradual with deterioration often happening over a number of days.

TREATMENT. During the early stages, encourage immediate contact with the local doctor. If this is difficult, or the condition deteriorates, take or send the person to hospital. Monitor airway and breathing and be prepared to resuscitate if necessary.

HYPOGLYCEMIA. Low blood sugar level has a quick and serious effect on the brain. Most commonly it is caused by somebody with diabetes either taking too much insulin, or taking the right amount of insulin and then either not eating enough or burning off sugar through vigorous exercise. Less commonly, it can accompany heat exhaustion, alcohol abuse, or epileptic fits.

TREATMENT. If the person is unconscious, monitor the airway and breathing and be prepared to resuscitate as necessary. If the person is fully conscious, help him to sit down or to lie down with the shoulders raised. Give something high in sugar and easy to consume, such as chocolate or a sugary drink,
to try to restore the body's chemical balance. If this marks an improvement, give more. If the condition does not improve, seek medical advice. Stay with the person until he recovers. Ask his guidance on what he wants to do next. Arrange for some help to take him home or to the doctor. If the condition continues to deteriorate, call an ambulance.

SIGNS AND SYMPTOMS
Early signs:

• Wanting to drink a lot (the body is trying to flush sugar from the system)
• Passing water regularly (urine may smell sweet)
• Lethargy

As the condition deteriorates:

• Dry skin and rapid pulse
• Deep, labored breathing
• Increasing drowsiness
• Breath or skin smells strongly of acetone (like nail-polish remover) as the body tries to get rid of sugar
• History of diabetes (however, a diabetic suffering a hypoglycemia attack is often confused or aggressive and  may not admit to having diabetes)
• Hunger
• Feeling faint or dizzy
• Strange behavior: confusion, aggression, or even violence
• Pale, cold, sweaty skin
• Rapid loss of consciousness
• Shallow breathing
• Evidence of diabetes, e.g. medic alert, sugar solution, or syringe in pocket
• Evidence of recent heavy exercise or drinking

CONFUSION WITH OTHER CONDITION

It is not unusual for diabetes to be mistaken for other common situations such as drunkenness, substance abuse, compression, or a stroke. The treatment in all these situations is to monitor and maintain the airway, be prepared to resuscitate if necessary, use the recovery position if the person becomes unconscious, and seek medical advice or call emergency help.

Do not make assumptions as to the cause of the problem. Instead, look for clues to diagnosis for the medical staff. Somebody who is drunk may also be suffering from head injury; the syringe in a person's coat may be for diabetic medication of for drug abuse. While you do not need to know the cause the medical staff do and any clues that you can hand over could be potentially life-saving.

BLEEDING
Blood is carried around the body in a transport system of arteries, capillaries, and veins, and any damage to this network results in bleeding. Bleeding can be both external and internal. External bleeding involves a break to the skin surface, known as a wound, which can take many different forms. Internal bleeding is bleeding that occurs inside the body when there is no external injury for the blood to escape from. The most common form of internal bleeding is a small bruise from a minor impact. Heavy impact from  car accidents, fights, or falls, for example, can lead to serious internal bleeding, which may kill.

TRANSPORT OF BLOOD. Arteries have thick muscular walls, that contract. This pushes blood out from the heart under pressure. The blood contained within them is full of oxygen, which has been collected from the lungs, and the main function of the arteries is to take this oxygen-rich blood to the organs and body tissue. Because the blood is under pressure, and is so full of oxygen, arterial bleeding is characterized by bright red blood pumping from an injury. Arterial bleeding is very serious as blood is rapidly lost.
     Veins have thin walls and return blood from the organs and tissues to the heart. They do not have muscles of their own and rely on the actions of the muscles around them to squeeze the blood around. To keep the blood moving in one direction around the body, they have series of one-way valves that ensure a one-way flow. When these valves deteriorate, blood pools in the veins, making them swell. This weakens the vein wall, resulting in a condition known as varicose veins. While the blood loss from a bleeding vein does not tend to be as quick as a bleeding artery, it does nonetheless have the potential to be a very serious and even fatal injury. Bleeding from a vein will seem to flow from an injury and  because it has little or no oxygen it will appear to be a dark red.
     Capillaries are very thin-walled vessels. Blood is forced through them under pressure, causing the nutrients and oxygen stored in the blood to be pushed out into the body tissues and organs.

TYPES OF INJURY. Small blood loss is very common and rarely needs much treatment. Large blood loss may lead, if untreated, to shock and, potentially, death.

Incisions. Clean and deep cuts characterized by paper cuts and knives are known as incisions. While these wounds do not tend to bleed a lot, there may be underlying damage to tendons and other tissues.

Lacerations are jagged wounds, which tend to bleed a lot.

Puncture wounds are, as their name suggest, deep injuries caused by a pointed object such as a knitting needle. They do not tend to bleed a great deal but they carry the risk of infection because dirt can be carried a long way into the tissue. There is also a greater risk of damage to vital organs such as the lungs or liver.

Scrapes are a commonplace injury and involve damage to the top layers of the skin. They do not cause major blood loss but often dirty, because grazes tend to have debris embedded within them.

HOW DOES THE BODY STOP BLEEDING?
When a blood vessel is torn or cut, a series of chemical reactions takes place that causes the formation of a blood clot to seal the injury. Components of the blood known as platelets clump together at the injury site. Damaged tissue and platelets release chemicals that activate proteins called clotting factors. These react with a special protein (fibrinogen) to form a mesh of filaments that traps blood cells. These form the basis of a blood clot that contains white blood cells to help fight infection and specialized blood cells that help promote repair and recovery. A scab will form to protect the wound until repair has taken place. When applying pressure to the site of wound you are helping the clotting process.

By: Unknown On 6:55 AM

Continue Reading

Unconsciousness and Epilepsy

Unconsciousness is an interruption of normal brain activity. It can happen suddenly or gradually. Unconsciousness can be caused by a range of injuries and medical conditions, as well as by a number of different drugs. An unconscious person may still have some reactions to pain or to commands, or may have no reactions at all.

Whatever the cause or degree of unconsciousness, the immediate emergency treatment remains the same:

• Assess whether the person is unconscious by gently squeezing the shoulders and asking a question.
• Open the airway by lifting the chin, clearing the mouth, and tilting the head. Check the breathing and be prepared to resuscitate if necessary.
• If breathing, check for life-threatening conditions and then turn into the recovery position.
• Call for emergency help.

This may be all that you have time to do before emergency help arrives. However, if you have longer, there are some things that you can do to gather information that may help medical staff with their diagnosis and treatment.

ASSESS THE LEVEL OF RESPONSE. There is an agreed scale for assessing how responsive an injured or ill person is-- the Glasgow Coma Scale. A fully alert person will score 15 while somebody who is totally unresponsive will score 3 with several variations in between. You can help collect information to inform medical staff using some of the checks from this scale:

EYES. Do they:

• Open without you having to ask the person to open them?
• Open on command?
• Open if you cause the person pain (this is often done by pinching the earlobe)?
• Remain closed?

MOVEMENTS. Does the person:

• Understand and follow sensible instructions?
• Move only in response to pain?
• Not move at all?

SPEECH. Does the person:

• Answer questions sensibly?
• Answer questions in a confused way?
• Make sounds that cannot be understood?
• Make no noise?

Do the checks of eyes, movement, and speech every 10 minutes and record your answers.

FAINTING

A faint is a brief loss of consciousness. Shock is one of the potential causes of fainting but other causes include lack of food, a reaction to emotional news, or long periods of inactivity, for example, guardsmen standing for a long time in the summer.

To treat someone who has fainted, open the airway and check for breathing. If the person is breathing and there are no signs of injury, then the best treatment is to lie her on her back with her legs raised. This puts maximum oxygen back to the brain and speeds up recovery from a faint. If she has not begun to come around after 3 minutes, or if breathing becomes difficult, put her into the recovery position and call for help.

EXAMINING THE UNCONSCIOUS PERSON

Your initial check of the injured or ill person will be for life-threatening conditions, particularly serious bleeding. If you have more time while waiting for the ambulance, a more thorough check may show up less serious injuries or illness and potential clues to the cause of unconsciousness. This check should never be at the cost of monitoring and maintaining the airway or of keeping the injured person as still as possible. If doing a check of the body, it is sensible to do so in the presence of a third person.

Check the body from head to toe, looking for areas of bleeding, signs of broken bones or burns, or clues as to the cause of unconsciousness.

MONITORING AND RECORD BREATHING

Breathing is measured by counting the number of breaths in 1 minute (one breath being one rise and fall of the chest).

MONITOR AND RECORD PULSE RATE

Pulse rate is measured by counting the number of beats at the pulse at either the neck or the wrist for 1 minute. The easiest place to feel a pulse is in the carotid artery in the neck, though you can also check the wrist. Take recordings of breathing and pulse rate every 10 minutes and write down the results for the medical staff.

EPILEPSY
Epilepsy is a very common condition, best described as a rogue electrical discharge across the brain. As the body's functions are controlled be electrical impulses this discharge can lead to a number of physical reactions. Many things may start a seizure (fit): tiredness, stress, or flashing lights are common triggers.

MAJOR SEIZURE
This is what most people would recognize as epilepsy, and there are typically four stages:

1. Many people get a sense that a seizure is likely to occur.
2. The electrical impulses lead to a contraction in the muscles that causes the epilepsy sufferer to fall to the ground with a cry. This is known as the tonic phase. The victim's muscles may then go into spasm. This is known as the clonic stage. During this stage the victim will not be breathing.
3. When the convulsion is over, the victim will be in a state of unconsciousness.
4. On recovery from unconsciousness, the victim will be very sleepy and will want to rest for some time.

MINOR FITS. During a minor fit, somebody with epilepsy suffers a brief disturbance in the brain's normal activity, leading to a lack of awareness of his or her surroundings. To the observer it might seem like the person is daydreaming or has suddenly switched off.

     There is little for you to do other than to guide the person away from danger and reassure him when he returns to normal. If he is not aware of any similar episodes happening before, advise him to see a doctor.

TREATMENT FOR A MAJOR EPILEPTIC SEIZURE

1. During the seizure, do not try to restrain the person. The muscular contractions are so strong during a fit that holding a person down may lead to broken bones-- yours and his. Do not attempt to put anything in the mouth. Try to protect the victim-- move sharp objects out of the way, remove constrictions and, if possible, place a soft coat under the head.
2. Once the seizure has finished, check the victim's airway and breathing and be prepared to resuscitate in the unlikely event that this is necessary. Place the person in the recovery position.
3. When the victim comes round, offer reassurance. The person may have lost control of bowel or bladder function so cover him up and, when he is steady on his feet, help him to find somewhere to clean up. He is likely to be very tired so, if possible, find him somewhere to lie down and sleep. Most of all, ask him what he wants to do-- most epileptics manage the condition very well and will have their own coping strategies.

INFANTILE CONVULSIONS (CAUSED BY HEAT)

Babies and young children may have seizures induced by a high temperature. This may be the result of an infection or because they are overwrapped and in a warm environment. The signs and symptoms are similar to a major epileptic seizure.

TREATMENT. Make sure that the child is protected from hitting himself on a bed or cot-- do not attempt to restrain. Cool down by removing bedclothes and clothing where possible. Sponge the head and under the arms with tepid flannel or sponge, re-soaking it regularly. When the convulsion is finished, check ABC and take action as appropriate. In most cases, the child will want to sleep. Dress him in dry clothes and let him sleep. Call a doctor for advice.

WHEN TO CALL AN AMBULANCE. Generally, neither epilepsy nor infantile convulsion are medical emergencies. However, you should be prepared to call an ambulance if:

• The victim is injured during the seizure.
• The seizure lasts for longer than 3 minutes.
• There are repeated seizures in a short period of time.
• The victim does not regain consciousness.

If it is the first time seizure, advise the victim to call his doctor or take him to hospital.

By: Unknown On 6:11 AM

Continue Reading

Heart problems and Stroke

The heart is a muscle that pumps blood around the body, which it does with the help of the thick-walled and muscular arteries and the other vessels of the circulatory system. The heart is controlled by regular electrical impulses that tell it when to contract. Like all other muscles, the heart needs its own blood supply  and this is provided by the coronary (heart) arteries. When this  blood supply fails to run smoothly, the body starts to experience problems, such as angina pectoris (angina) and heart attack. Either of these may lead to the heart stopping (cardiac arrest).

ANGINA. Throughout life, arteries are clogging up with fatty deposits. As these fatty deposits cause the coronary and other arteries to become narrower, it becomes increasingly difficult for blood to flow around the body. The clogged coronary arteries can just about supply blood to the heart when it is pumping at a normal rate but when the heart rate speeds up the arteries cannot cope with the demand. This leads to an angina attack, a frightening, severe, crushing chest pain that acts as a warning to the victim to calm down or to rest.

TREATMENT

1. Sit the victim down and reassure her. This reduce the demands being placed on the heart.
2. Angina sufferers may have medicine that will help relieve an attack. This is often in the form of a puffer or a pill that is placed under the tongue. The drug works by dilating the blood vessels, thereby increasing circulation to the heart. Help the victim to take this medication.
3. Call an ambulance if the pain does not appear to ease or if the victim is not a known angina sufferer.
4. If the victim has regular attacks, listen to what she wants to do next.

SIGNS AND SYMPTOMS OF ANGINA

• Evidence of recent exertion
• Previous history of angina attacks
• Gripping chest pain, often described by the sufferer as vise-like
• Pain spreading up into the jaw or down into the left arm
• Feeling of tingling down the arm
• Shortness of breath
• Dizziness and confusion
• Anxiety
• Pale skin which possible blue tinges
• Rapid, weak pulse

HEART ATTACK. If a coronary artery becomes completely blocked, the area of the heart being supplied by that particular blood vessel will be starved of oxygen and will eventually die. This blockage may be caused by a clot, a condition often referred to as a coronary thrombosis.

     The development of advanced cardiac care in hospital and good post-hospital care means that heart attack patients have a good chance of making a full recovery. This is important information to remember when you are reassuring somebody having a heart attack.

SIGNS AND SYMPTOMS OF HEART ATTACK

This signs and symptoms are generally the same as those of angina-- indeed, the patient may initially suffer an angina attack that becomes a heart attack. The key difference is that heart attacks do not always follow physical exertion. While angina sufferers will recover from their attack on resting, heart attack patients do not tend to improve without medical treatment.

TREATMENT

1. Move the victim into semi-sitting position head and shoulders supported and knees bent, as this is generally the best position to breathe in.
2. Reassure the victim and do not let her move, as this will place an extra strain on the heart.
3. Call for an ambulance as soon as possible because the victim needs hospital care.
4. If the victim has angina medication, let her take this. If you have an ordinary aspirin, give her one to chew (without water).
5. Keep a continual check on the breathing and pulse and be prepared to resuscitate in necessary.

STROKE

A stroke occurs when a blood clot or bleeding cuts off the blood supply, and therefore the oxygen, to part of the brain. The affected area of the brain will eventually die. The effect of a stroke depends on how much of the brain is affected and where the clot or bleeding is. Different parts of the brain control different functions, so a clot in the part of the brain that controls speech, for example, will result in slurred or confused speech. Often the signs will be confined to one side of the body.

EFFECTS OF STROKE. If the bleeding or clot is in one of the larger blood vessels supplying a large area of the brain, then the stroke will often be immediately fatal. However, many people do survive, with some making a full recovery. Others may need extensive periods of rehabilitation and support to manage stroke-related problems such as reduced mobility.

TREATMENT. Monitor airway and breathing and be prepared to resuscitate if necessary. Place the person in the recovery position if she becomes unconscious. If she is conscious, help her to lie down with the head and shoulders slightly raised. Provide support and reassurance. The person will often be disoriented and may be speaking nonsense if the speech center is affected. Equally, she may hear what you are saying but not understand it. Speak in a reassuring tone with confidence. Call an ambulance. Wipe any dribbling away from the side of the face and be prepared for the person to vomit.

SIGNS AND SYMPTOMS
Any combination of the following may be present. In minor strokes, the signs and symptoms may be very limited.

• History-- the sufferer may have a history of smaller strokes over previous years, or may have been feeling unwell for some days with no known cause.
• Headache
• Blurred vision, partial loss of sight, or seeing flashing lights.
• Confusion and disorientation, often mistaken for drunkenness.
• Signs of paralysis or weakness, often only down one side of the body (confirm by asking the patient to hold out both arms in front of her and look for drooping or shaking).
• Difficulty speaking; drooping mouth or smile (caused by minor paralysis).
• Dribbling from one side of the mouth
• Loss of consciousness (this can be gradual or sudden).
• Sometimes the pulse will be full and throbbing, the person's breathing noisy, and the skin flushed.

By: Unknown On 7:05 AM

Continue Reading